肌腱组织工程的研究进展

肌腱缺损一直是整形外科关注的重要问题之一，这是因为自体肌腱移植来源有限，异体肌腱移植存在免疫排斥反应，而很多替代物在肌腱修复应用中无法获得满意的远期疗效。随着组织工程技术的发展，组织工程化肌腱为修复肌腱缺损开辟了一条新途径。     

整形和美容外科中组织移植的基本知识与技术

在整形和美容外科的治疗技术中，以修复组织、再造器官为目的的组织移植术是被广泛应用的治疗手段之一。除了利用率较高的皮肤移植术外，脂肪、骨胳肌、骨与软骨、筋膜和多种复合组织都可以进行移植。随着显微外科技术的发展，把显微外科技术运用到组织移植中，极大地提高了移植组织的成活率。近年来，组织工程技术的兴起，为组织移植提供了更为广泛的发展空问。作为整形和美容外科医师，组织移植的基本知识与技术是应该熟悉并掌握的重要内容。     

组合组织移植修复足踝部严重组织缺损

1995年 10月～ 2 0 0 0年 3月作者采用组合组织移植的方法 ,修复 18例足踝部严重组织缺损 ,保留和重建足踝部功能 ,获满意效果 ,报道如下。临床资料本组男 16例 ,女 2例。年龄 5～ 5 4岁。平均 2 8岁。其中12例为交通肇事引起 ,4例机械损伤 ,1例为烧伤 ,1例为火器伤所致。急诊手术 10例 ,感染创面择期手术 3例 ,晚期手术 5例。足部组织缺损 5例 ,单纯踝关节组织缺损 2例 ,足踝部组织缺损 11例 ,其中皮肤软组织缺损 12例 ,合并跟腱、血管、神经缺损2例 ,合并骨关节缺损 4例。方法 :股前外侧皮瓣与胸脐皮瓣组合移植 8例 ,双侧股前外侧皮瓣组合…     

皮瓣移植修复组织缺损临床分析

目的 分析研究皮瓣移植修复组织缺损的临床效果。 方法 应用１３种类型的皮瓣移植修复组织缺损１３３例,皮瓣类型有肩胛皮瓣１１例,股前外侧皮瓣２６例,侧腹部皮瓣１１例,足背皮瓣９例,前臂皮瓣１３例,腓肠神经营养血管皮瓣１０例,下腹部皮瓣３１例,还有小腿内侧皮瓣、小腿外侧皮瓣、腓肠肌皮瓣、背阔肌皮瓣及阔筋膜张肌皮瓣等２例。其中吻合血管皮瓣游离移植修复６２例,带血管蒂岛状皮瓣移植修复７１例。 结果 有２例     

组织移植修复手部肿瘤切除后的组织缺损

手部骨及软组织肿瘤的治疗,原则是既要彻底,又要尽可能地保全肢体和重建功能。现将我们治疗的11例手部肿瘤小结如下。 临 床 资 料 本组共11例,男6例,女5例。年龄14～50岁。桡骨远端骨巨细胞瘤6例;第二掌骨腱鞘巨细胞瘤1例;第三掌骨巨大孤立性骨囊肿1例;手腕背部海绵状血管瘤1例;左手腕背部透明细胞汗腺癌1例;右手拇指腹侧腱路巨细胞瘤1例。治疗方法:骨     

组织瓣移植修复肿瘤切除术后组织缺损

1984年10月～1989年9月,以吻合血管或非吻合血管的组织瓣移植,修复肿瘤切除后的组织缺损13例,移植组织全部成活,组织修复及功能恢复满意。临床资料本组男性8例、女性5例,年龄19～66岁。病程0.5～13年,病因:足背血管瘤并溃疡、胫骨软骨瘤、软骨粘液样纤维瘤、拇指血管瘤各...     

自体脾组织片移植的临床观察

自体脾组织片移植的临床观察李益民崔宏何三光刘永锋我院从１９８１年１月至１９９６年１月共行外伤性脾切除后的自体脾组织片移植１４例，术后观察效果良好，现报告如下：脾破裂行自体脾组织片移植共１４例，男１１例，女３例。年龄６～５７岁，平均３３．５岁，其中脾组...     

脾损伤自体脾组织移植的研究进展

脾移植可起一部分抗感染作用，目前对移植后脾组织的免疫功能尚有不同的看法，在未全面阐明的情况下，仍不应放弃脾组织移植术。移植部位以为宜，如脾损伤严重伴有腹腔污染时可行腹膜外移植。     

Microsurgical Composite Tissue Transplantation

Since 1974, 69 patients with extensive defects have undergone reconstruction by microsurgical composite tissue transplantation. Using this method, donor composite tissue is isolated on its blood supply, removed to a distant recipient site, and the continuity of blood flow re-established by microvascular anastomoses. In this series, 56 patients (81%) were completely successful. There have been eight (12%) failures, primarily in the extremities. There have been five (7%) partial successes, (i.e., a microvascular flap in which a portion was lost requiring a secondary procedure such as a split thickness graft). In those patients with a severely injured lower extremity, the failure rate was the greatest. Most of these were arterial (six of seven). These failures occurred early in the series and were thought to be related to a severely damaged recipient vasculature. This problem has been circumvented by an autogenous interpositional vein graft, permitting more mobility of flap placement. In the upper extremity, all but one case were successful. Early motion was permitted, preventing joint capsular contractures and loss of function. Twenty-three cases in the head and neck region were successful (one partial success). This included two composite rib grafts to the mandible. Prolonged delays in reconstruction following extirpation of a malignancy were avoided. A rapid return to society following complete reconstruction was ensured. Nine patients presented for reconstruction of the breast and thorax following radical mastectomy. All were successfully reconstructed with this new technique except one patient. Its many advantages include immediate reconstruction without delayed procedures and no secondary deformity of the donor site. Healthy, well vascularized tissue can now be transferred to a previously irradiated area with no tissue loss. This new method offers many advantages to older methods of reconstruction. Length of hospital stay and immobilization are reduced. The total number of operative procedures required in achieving the desired result is also less, thus decreasing the cost of hospital care.     

Matrix-Assisted Transplantation of Functional Beige Adipose Tissue

Novel, clinically relevant, approaches to shift energy balance are urgently needed to combat metabolic disorders such as obesity and diabetes. One promising approach has been the expansion of brown adipose tissues that express uncoupling protein (UCP) 1 and thus can uncouple mitochondrial respiration from ATP synthesis. While expansion of UCP1-expressing adipose depots may be achieved in rodents via genetic and pharmacological manipulations or the transplantation of brown fat depots, these methods are difficult to use for human clinical intervention. We present a novel cell scaffold technology optimized to establish functional brown fat–like depots in vivo. We adapted the biophysical properties of hyaluronic acid–based hydrogels to support the differentiation of white adipose tissue–derived multipotent stem cells (ADMSCs) into lipid-accumulating, UCP1-expressing beige adipose tissue. Subcutaneous implantation of ADMSCs within optimized hydrogels resulted in the establishment of distinct UCP1-expressing implants that successfully attracted host vasculature and persisted for several weeks. Importantly, implant recipients demonstrated elevated core body temperature during cold challenges, enhanced respiration rates, improved glucose homeostasis, and reduced weight gain, demonstrating the therapeutic merit of this highly translatable approach. This novel approach is the first truly clinically translatable system to unlock the therapeutic potential of brown fat–like tissue expansion.     

组合组织移植修复复杂手外伤

目的　介绍采用组合组织移植修复复杂手外伤的方法。方法　第 2～ 5指毁损伤采用双侧第二趾移植 (2块组织 ) 7例 ,双侧第二趾带拇趾腓侧皮瓣 (2块组织 ) 3例 ;第 2～ 5指毁损伴手掌、手背皮肤撕脱伤采用双侧第二趾加股前外侧皮瓣 (3块组织 ) 8例 ;第 1～ 5指毁损伴手掌皮肤撕脱伤采用拇甲瓣与另一侧第二趾加股前外侧皮瓣 (3块组织 ) 1例 ;第 1～ 5指毁损伴手掌、手背皮肤撕脱伤采用拇甲瓣、双侧第二趾加股前外侧皮瓣 (4块组织 ) 1例。结果　 2 0例 5 1块游离组织移植全部成活 ,功能良好。结论　组合组织移植是修复复杂手外伤的理想方法。     

组织瓣移植修复严重足创伤后软组织缺损

自1985年至1992年应用组织瓣移植同时修复严重足外伤后皮肤、神经、肌腱等组织缺损68例,皮瓣全部成活。随访1～5年,皮瓣外观良好,足功能恢复满意。本文就如何根据伤情选用不同类型的组织瓣及术中有关问题进行了讨论。     

The International Registry on Hand and Composite Tissue Transplantation

BACKGROUND: Since May 2002 all groups performing hand transplantations have supplied detailed information to the International Registry on Hand and Composite Tissue Transplantation. This inaugural report provides a review of all hand transplants performed to date. METHODS: Between September 1998 and September 2004, 18 male patients underwent 24 hand/forearm/digit transplantations (11 monolateral and 4 bilateral hand transplantations, 2 bilateral forearm transplantations, and 1 thumb transplantation). The level of amputation was mostly at the distal forearm or wrist. The average age of the patient was 32 years. Time since hand loss ranged from 2 months to 22 years. Immunosuppressive therapy included tacrolimus, mycophenolate mofetil, rapamycin, and steroids; polyclonal or monoclonal antibodies were used for induction. Topical immunosuppression was administered in some patients. Follow-up period ranged from 17 to 70 months. RESULTS: Patient survival was 100%. Graft survival was 100% at 1 and 2 years. Two cases of graft failure at a later date were caused by severe inflammation and progressive rejection in a noncompliant patient. Acute rejection episodes occurred in 12 patients within the first year. Rejection was reversible in all compliant patients. Side effects included opportunistic infections and metabolic complications. No life-threatening complications or malignancies were reported. All patients had achieved protective sensation, and 17 patients also achieved discriminative sensation. Extrinsic and intrinsic muscle recovery enabled patients to perform most daily activities. CONCLUSIONS: Despite the enormous antigen load associated with composite tissue allograft, hand transplantation became a clinical reality with immunosuppression comparable to transplantation of solid organs.     

Obesity‐Associated Adipose Tissue Inflammation and Transplantation

Obesity is often associated with the development of adipose tissue (AT) inflammation, resulting in metabolic dysfunction and an increased risk for developing type 2 diabetes. It is also associated with multiple chronic diseases, including cardiovascular, liver, and kidney disease, and thus can contribute to organ failure. Several studies have investigated whether there is a correlation between obesity and outcomes in transplantation, but there is currently very limited information on the specific role of AT inflammation in the rejection process or on the overall function of the transplanted organ. Here, we provide a brief review of the current understanding of the cellular mechanisms that control obesity‐associated AT inflammation and summarize knowledge about how obesity affects clinical outcomes following solid organ or hematopoietic stem cell transplantation. We also highlight opportunities for more research to better understand how obesity affects outcomes of transplantation.     

Trend Analysis of Organ and Tissue Donation for Transplantation

Background

The goal of this study was to identify the tendency toward donations of tissue and organs from donors with brain death between 2001 and 2016 as registered by an organ procurement organization in São Paulo City.